Intraepidermal Nerve Fiber Density Testing

Policy ID: L-4-015

Section: Laboratory

Effective Date: May 01, 2020

Revised Date: January 08, 2024

Revision Effective Date: May 05, 2025

Last Reviewed: March 11, 2025

Applies To: Commercial and Medicaid Expansion

Description

Skin biopsy is used to assess the density of epidermal (intraepidermal) and sweat gland (sudomotor) nerve fibers using antibodies to a marker found in peripheral nerves. This procedure is proposed as an objective measure of small fiber neuropathy by identifying a reduction in the density of nerve fibers.

Policy Application

All claims submitted under this policy's section will be processed according to the policy effective date and associated revision effective dates in effect on the date of processing, regardless of service date; and/or

All claims submitted under this policy's section will be processed according to the policy effective date and associated revision effective dates in effect on the date of service.

Criteria

Coverage is subject to the specific terms of the member's benefit plan.

Skin Biopsy

Policy Application

Skin biopsy with epidermal nerve fiber density measurement for the diagnosis of small-fiber neuropathy may be considered medically necessary when ALL of the following conditions are met:

Individual presents with symptoms of painful sensory neuropathy; and
There is no history of a disorder known to predispose to painful neuropathy (e.g., diabetic neuropathy, toxic neuropathy, HIV neuropathy, celiac neuropathy, inherited neuropathy); and
Physical examination shows no evidence of findings consistent with large-fiber neuropathy, such as reduced or absent muscle-stretch reflexes or reduced proprioception and vibration sensation; and
Electromyography and nerve-conduction studies are normal and show no evidence of large-fiber neuropathy.

Skin biopsy with epidermal nerve fiber density measurement not meeting the criteria as indicated in this policy is considered experimental/investigational and therefore, non-covered because the safety and/or effectiveness of this service cannot be established by the available published peer-reviewed literature.

Procedure Codes

11102

11103

11104

11105

11106

11107

Measurement of Sweat Gland Nerve Fiber Density

Policy Application

All claims submitted under this policy's section will be processed according to the policy effective date and associated revision effective dates in effect on the date of service.

Measurement of sweat gland nerve fiber density is considered experimental/investigational and therefore, non-covered because the safety and/or effectiveness of this service cannot be established by the available published peer-reviewed literature.

Non-Covered Procedure Code

88356

Diagnosis Codes

Not Applicable

Professional Statements and Societal Positions Guidelines

Not Applicable

ND Committee Review

Internal Medical Policy Committee 3-16-2020 New Policy

Internal Medical Policy Committee 3-17-2021 Annual Review - no changes in criteria

Internal Medical Policy Committee 7-22-2021 Coding update:

Removing codes 88305; 88314; and 88356.

Internal Medical Policy Committee 11-23-2021

Updated with clarifying language

Internal Medical Policy Committee 7-21-2022 Revision with coding update - Effective September 05, 2022

Added Non-covered procedure code 88356

Internal Medical Policy Committee 1-16-2024 Coding update - Effective March 04, 2024

Removed procedure code 88342

Internal Medical Policy Committee 1-14-2025 Annual Review-no changes in criteria

Added Policy Application

Internal Medical Policy Committee 3-11-2025 Annual Review -no changes in criteria

Updated Policy Application

Links

References (PDF)

Disclaimer

Current medical policy is to be used in determining a Member's contract benefits on the date that services are rendered. Contract language, including definitions and specific inclusions/exclusions, as well as state and federal law, must be considered in determining eligibility for coverage. Members must consult their applicable benefit plans or contact a Member Services representative for specific coverage information. Likewise, medical policy, which addresses the issue(s) in any specific case, should be considered before utilizing medical opinion in adjudication. Medical technology is constantly evolving, and the Company reserves the right to review and update medical policy periodically.

Policy ID: L-4-014

Section: Laboratory

Effective Date: May 01, 2020

Revised Date: January 08, 2024

Revision Effective Date: March 03, 2025

Last Reviewed: January 14, 2025

Archived Date: May 04, 2025

Applies To: Commercial and Medicaid Expansion

Description

Skin biopsy is used to assess the density of epidermal (intraepidermal) nerve fibers using antibodies to a marker found in peripheral nerves. This procedure is proposed as an objective measure of small fiber neuropathy by identifying a reduction in the density of nerve fibers.

Policy Application

All claims submitted under this policy's section will be processed according to the policy effective date and associated revision effective dates in effect on the date of service.

Criteria

Coverage is subject to the specific terms of the member's benefit plan.

Skin biopsy with epidermal nerve fiber density measurement for the diagnosis of small-fiber neuropathy may be considered medically necessary when ALL of the following conditions are met:

Individual presents with symptoms of painful sensory neuropathy; and
There is no history of a disorder known to predispose to painful neuropathy (e.g., diabetic neuropathy, toxic neuropathy, HIV neuropathy, celiac neuropathy, inherited neuropathy); and
Physical examination shows no evidence of findings consistent with large-fiber neuropathy, such as reduced or absent muscle-stretch reflexes or reduced proprioception and vibration sensation; and
Electromyography and nerve-conduction studies are normal and show no evidence of large-fiber neuropathy.

Procedure Codes

11102

11103

11104

11105

11106

11107

Measurement of Sweat Gland Nerve Fiber Density

Policy Application

All claims submitted under this policy's section will be processed according to the policy effective date and associated revision effective dates in effect on the date of service.

Non-Covered Procedure Code

88356

Diagnosis Codes

Not Applicable

Professional Statements and Societal Positions Guidelines

Not Applicable

ND Committee Review

Internal Medical Policy Committee 3-16-2020 New Policy

Internal Medical Policy Committee 3-17-2021 Annual Review - no changes in criteria

Internal Medical Policy Committee 7-22-2021 Coding update:

Removing codes 88305; 88314; and 88356.

Internal Medical Policy Committee 11-23-2021

Updated with clarifying language

Internal Medical Policy Committee 7-21-2022 Revision with coding update - Effective September 05, 2022

Added Non-covered procedure code 88356

Internal Medical Policy Committee 1-16-2024 Coding update - Effective March 04, 2024

Removed procedure code 88342

Internal Medical Policy Committee 1-14-2025 Annual Review-no changes in criteria

Added Policy Application

Medical Policies Quick Search

Intraepidermal Nerve Fiber Density Testing

Description

Policy Application

Criteria

Skin Biopsy

Policy Application

Procedure Codes

Measurement of Sweat Gland Nerve Fiber Density

Policy Application

Non-Covered Procedure Code

Diagnosis Codes

Professional Statements and Societal Positions Guidelines

ND Committee Review

Links

Disclaimer

Description

Policy Application

Criteria

Procedure Codes

Measurement of Sweat Gland Nerve Fiber Density

Policy Application

Non-Covered Procedure Code

Diagnosis Codes

Professional Statements and Societal Positions Guidelines

ND Committee Review

Links

Disclaimer